Abstract
Background: Medication and dietary nonadherence are precipitating factors for heart failure (HF) hospitalization; however, the characteristics, outcomes, and quality of care of patients with nonadherence are unknown. Recognizing features of nonadherent patients may provide a means to reduce rehospitalization for this population. Methods: GWTG-HF registry data were collected from 236 hospitals and 54,322 patients from January 1, 2005 to December 30, 2007. Demographics, clinical characteristics, in-hospital outcomes, and quality of care were stratified by precipitating factor for HF admission. Multivariate logistic regression analysis was used to determine the association of nonadherence with length of stay (LOS) and in-hospital mortality. Results: Clinicians documented dietary and/or medication nonadherence as the reason for admission in 5576 (10.3%) of HF hospitalizations. Nonadherent patients were younger and more likely to be male, minority, uninsured, and have nonischemic HF. These patients had lower ejection fractions (34.9% vs 39.6%, P < .0001), more frequent previous HF hospitalizations, higher brain natriuretic peptide levels (1813 vs 1371 pg/mL, P < .0001), and presented with greater signs of congestion. Despite this, nonadherent patients had shorter LOS (odds ratio 0.94, 95% CI 0.92-0.97) and lower in-hospital mortality (odds ratio 0.65, 95% CI 0.51-0.83) in multivariate analysis. Although nonadherent patients received high rates of Joint Commission core measures, rates of other evidence-based treatments were less optimal. Conclusions: Nonadherence is a common precipitant for HF admission. Despite a higher risk profile, nonadherent patients had lower in-hospital mortality and LOS, suggesting that it may be easier to stabilize nonadherent patients by reinstituting sodium and/or fluid restriction and resuming medical therapy.
| Original language | English (US) |
|---|---|
| Pages (from-to) | 644-652 |
| Number of pages | 9 |
| Journal | American heart journal |
| Volume | 158 |
| Issue number | 4 |
| DOIs | |
| State | Published - Oct 2009 |
Funding
Dr Fonarow reports receiving research grants and honoraria from GlaxoSmithKline and Medtronic and serves as a consultant for GlaxoSmithKline, Medtronic, and Novartis. He serves as chair of the American Heart Association’s Get With the Guidelines Steering Committee. He is supported by the Ahmanson and Elliot Corday Foundations. Dr Hernandez reports receiving research grants from Scios, Medtronic, GlaxoSmithKline, and Roche Diagnostics and has served on the speaker’s bureau or has received honoraria in the past 5 years from Novartis. Dr Yancy reports no active consulting or speaker bureau relationships. He continues to hold a non-compensated research relationship with Medtronic and has an editorial relationship with theheart.org and several cardiology journals. Dr Yancy does have contracts with the FDA and NIH. He currently holds a volunteer leadership role with the American Heart Association. Dr Krantz has received investigator initiated research grant support from GlaxoSmithKline and serves on their speaker’s bureau. He has received speaker honorarium in the last five years from Pfizer, Novartis, and Sanofi-BMS. He volunteers for the American Heart Association locally and serves on the national Get With the Guidelines Steering Committee. Dr Ambardekar is supported by a 2009 Research Fellowship Award from the Heart Failure Society of America.
ASJC Scopus subject areas
- Cardiology and Cardiovascular Medicine